World journal of surgery
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World journal of surgery · Mar 2010
Randomized Controlled TrialParacetamol reduces postoperative pain and rescue analgesic demand after robot-assisted endoscopic thyroidectomy by the transaxillary approach.
Postoperative pain following endoscopic thyroidectomy, although less severe than after open methods, is still a source of marked discomfort and surgical stress. This clinical trial was conducted to determine if repeated intravenous paracetamol could decrease postoperative pain and rescue analgesic requirements after robot-assisted endoscopic thyroidectomy via the transaxillary approach. ⋯ We concluded that repeated administration of 1 g of intravenous paracetamol over 24 h is easy, effective, safe, and well tolerated for pain management in patients with moderate to severe postoperative pain after gasless robot-assisted endoscopic thyroidectomy performed via the transaxillary approach.
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World journal of surgery · Mar 2010
Comparative StudyA comparison of three scores to screen for delirium on the surgical ward.
Postoperative delirium is associated with adverse outcome. The aim of this study was to find a valid and easy-to-use tool to screen for postoperative delirium on the surgical ward. ⋯ All scores showed high specificity but differed in their sensitivity. The Nu-DESC proved to be the most sensitive test for screening for a postoperative delirium on the surgical ward followed by the CAM and DDS when compared to the gold standard.
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World journal of surgery · Mar 2010
Randomized Controlled TrialPrediction of LT4 replacement dose to achieve euthyroidism in subjects undergoing total thyroidectomy for benign thyroid disorders.
Total thyroidectomy is becoming the preferred choice of treatment in patients with benign disorders of the thyroid gland; hence, an optimal method of replacing thyroxine is essential to avoid the ill effects of over- and under-replacement of thyroxine in such patients. ⋯ Patients undergoing total thyroidectomy may require higher doses of thyroxine to achieve euthyroidism when compared to patients with similar anthropometric parameters having primary hypothyroidism. The method of replacing thyroxine based on LBM is the ideal method, but replacement based on fixed-dose regimens could be a good method if the body weight is taken into consideration.
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World journal of surgery · Mar 2010
Hypo- and hypernatraemia in surgical patients: is there room for improvement?
Up to 30% of surgical inpatients develop complications related to fluid and electrolyte therapy. We sought to study the occurrence of hypo- and hypernatraemia in these patients to inform current standards of care. ⋯ Four percent of surgical inpatients developed dysnatraemias, which were associated with increased mortality. Fluid balance documentation was suboptimal and daily weights were not measured routinely, even in patients with severe electrolyte derangements.
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World journal of surgery · Mar 2010
Historical ArticleSurgeons without borders: a brief history of surgery at Médecins Sans Frontières.
Médecins Sans Frontières (MSF) is a humanitarian organization that performs emergency and elective surgical services in both conflict and non-conflict settings in over 70 countries. In 2006 MSF surgeons departed on approximately 125 missions, and over 64,000 surgical interventions were carried out in some 20 countries worldwide. Historically, the majority of MSF surgical projects began in response to conflicts or natural disasters. ⋯ When there is a decrease in acute needs a program will be closed, or more importantly, turned over to the Ministry of Health or another non-governmental organization. The long-term solution to alleviating the global burden of surgical disease lies in building up a domestic surgical workforce capable of responding to the major causes of surgery-related morbidity and mortality. However, given that even countries with the resources of the United States suffer from an insufficiency of surgeons, the need for international emergency organizations to provide surgical assistance during acute emergencies will remain for the foreseeable future.